Retrograde crossing of peripheral occlusions: Long-term results and outcome predictors

Room 5 - Global Expert Exchange

Deep dive session: Lower limb interventions (part I)

Stanislaw Bartus

Jagiellonian University

Krakow, Poland

Disclosure

Speaker name:

.......Stanislaw Bartus...................................................

I have the following potential conflicts of interest to report:

Consulting

Employment in industry

Stockholder of a healthcare company

Owner of a healthcare company

Other(s)

I do not have any potential conflict of interest

Predictors of mortality and outcomes after retrogradeendovascular angioplasty in patients with peripheral

artery disease

Semmelweis University, Budapest, Hungary

Szent-Györgyi Albert Medical University, Kecskemét, Hungary

Jagiellonian University Medical College, Krakow, Poland

Pawel Kleczynski, Zoltan Ruzsa, Joanna Wojtasik-Bakalarz, Andras Nyerges,

Artur Dziewierz, Rafał Januszek, Tomasz Rakowski,

Dariusz Dudek, Stanislaw Bartus

Kleczynki P, Ruzsa Z, (…) Bartus S Adv Interv Cardiol 2019; 15, 2 (56): 234–239

Ruzsa Z. ,Wojtasik J(,..,) Bartus S J Invasive Cardiol. 2017 Oct;29(10):336-339

939 / 834 patients (63 % male),

68 (± 8 years).

36 months follow up

Inclusion criteria:

Percutaneous retrograde recanalization.

Kleczynki P, Ruzsa Z, (…) Bartus S Adv Interv Cardiol 2019; 15, 2 (56): 234–239Ruzsa Z. ,Wojtasik J(,..,) Bartus S J Invasive Cardiol. 2017 Oct;29(10):336-339

Predictors of mortality and outcomes after retrograde endovascular angioplasty in 834 patients with peripheral artery disease

Predictors of mortality and outcomes after

retrograde endovascular angioplasty

in 834 patients with peripheral artery disease

Adv Interv Cardiol 2019; 15, 2 (56): 234–239

Mortality and outcomes after retrograde

endovascular angioplasty in

patients with peripheral artery disease (n=834).

Kleczynski P., Ruzsa Z. et all Advances in interventional cardiology 2019

64.7%

Predictors of mortality and outcomes after retrograde endovascular

angioplasty in 834 patients with peripheral artery disease

Adv Interv Cardiol 2019; 15, 2 (56): 234–239

SFA

834 patients (63 % male),

68 (± 8 years).

Percutaneous retrograde recanalization.

Procedural success (of 939) - 92%.

In-hospital observation (of 86 pts):

proximal hematoma (9.3%),

vascular perforation/bleeding (4.7%),

distal hematoma (4.7%),

puncture site bleeding (3.5%)

pseudoaneurysm (1.2%),

thrombosis (1.2%),

local inflammation (1.2%).

Predictors of mortality and outcomes after retrograde

endovascular angioplasty in 834 patients with

peripheral artery disease.

Kleczynki P, Ruzsa Z, (…) Bartus S Adv Interv Cardiol 2019; 15, 2 (56): 234–239Ruzsa Z. ,Wojtasik J(,..,) Bartus S J Invasive Cardiol. 2017 Oct;29(10):336-339

Mortality and outcomes after retrograde

endovascular angioplasty in

patients with peripheral artery disease (n=834).

MACE

@10 years FU

86,6% 17%

34,6%

Kleczynki P, Ruzsa Z, (…) Bartus S Adv Interv Cardiol 2019; 15, 2 (56): 234–239Ruzsa Z. ,Wojtasik J(..) Bartus S J Invasive Cardiol. 2017 Oct;29(10):336-339

39,7%

Stroke/TIA

Log-Rank test p-value is equal to <0.0001* Log-Rank test p-value is equal to 0.0007*

COPD

Log-Rank test p-value is equal to 0.0011*

Renal Insufficiency

Log-Rank test p-value is equal to 0.0192*

Smoking

Mortality and outcomes after retrograde endovascular

angioplasty in patients with peripheral artery disease n=834

Log-Rank test p-value is equal to 0.0430*

Diabetes mellitus BMI

Log-Rank test p-value is equal to 0.05*

Mortality and outcomes after retrograde endovascular

angioplasty in patients with peripheral artery disease n=834

Predictors of mortality rate after 36 months:

history of stroke (HR for stroke 2.4, 95% confidence interval (CI) 1.55-3.66; p=0.0002)

Age (HR for age per 10 years 1.37, 95% (CI) 1.15-1.64; p=0.0002)

Rutherford category, (HR for Rutherford category 1.63, 95% CI (1.35-1.98); p< 0.0001)

chronic limb ischemia (HR for chronic limb ischemia 0.44, 95% CI (0.25-0.8), p=0.007)

chronic kidney disease (CKD) (HR for CKD 1.73, 95% CI (1.14-2.56), p=0.01)

COPD (HR for COPD 2.4, 95% CI (1.5-3.7), p=0.0004);

previous revascularization (HR for previous ER 0.59, 95% CI (0.35-0.94), p=0.02).

Predictors of secondary endpoint

(death, reER and amputation)

diabetes (HR 1.3, 95% CI (1.07-1.55, p<0.0075),

Rutherford category (HR 1.27, 95% CI (1.18-1.37), p<0.0001)

history of stroke (HR 1.41, 95% CI (1.05-1.86), p=0.02), all age-adjusted.

Independent predictors of tertiary composite end point (death, reER, amputation, myocardial infarction, lower extremity bypass and thrombendaterectomy).

Rutherford grade (HR 1.21, 95% CI (1.13-1.3), p<0.0001),

coronary artery disease (HR 1.4, 95% CI (1.16-1.67), p=0.0003)

history of stroke (HR 1.38, 95% CI (1.03-1.81), p=0.02)

Mortality and outcomes after retrograde

endovascular angioplasty in

patients with peripheral artery disease (n=834)

Multivariate analysis

Kleczynski P., Ruzsa Z. et all Advances in interventional cardiology 2019

Long-term follow-up shows that

- retrograde recanalization results in high rate of technical success

with low complication rate

- need for reinterventions in 40% of pts

- relatively high survival rate

- history of stroke, Rutherford level, CKD, COPD, and previous

endovascular revascularization of other lesion were independently

associated with increased risk of all-cause death

Kleczynki P, Ruzsa Z, (…) Bartus S Adv Interv Cardiol 2019; 15, 2 (56): 234–239

Ruzsa Z. ,Wojtasik J(,..,) Bartus S J Invasive Cardiol. 2017 Oct;29(10):336-339

Outcomes after

retrograde endovascular angioplasty

Conclusions:

Long-term follow-up after retrograde recanalisation of superficial femoral artery

chronic total occlusion

TECHNICAL FORUM

CLI and CTO summit – complex aortoiliac and femoral interventions

Stanislaw Bartus

Jagiellonian University

Krakow, Poland